U.S. DEPARTMENT OF THE INTERIOR Office of Occupational Safety and Health Medical Program Handbook Fifth Edition Produced by: Office of Occupational Safety and Health Division of Occupational Health and Medical Programs Table of Contents INTRODUCTION AND SCOPE ......................................................................................................................................... 5 HANDBOOK ADMINISTRATION ..................................................................................................................................... 7 CHAPTER 1 - RESPONSIBILITIES ..................................................................................................................................... 8 1.1 DOI OFFICE OF OCCUPATIONAL SAFETY AND HEALTH (OSH) ............................................................................................... 8 1.2 DOI OFFICE OF HUMAN RESOURCES ............................................................................................................................... 8 1.3 BUREAU SENIOR MANAGEMENT .................................................................................................................................... 8 1.4 BUREAU AREA/REGIONAL MANAGEMENT ........................................................................................................................ 9 1.5 LOCAL OFFICES ........................................................................................................................................................... 9 CHAPTER 2 - ROLES ..................................................................................................................................................... 10 2.1 OCCUPATIONAL HEALTH AND MEDICAL PROGRAMS ......................................................................................................... 10 2.2 DOI MEDICAL OFFICER (DOI MO) .............................................................................................................................. 10 2.3 AGENCY AND/OR PROGRAM MEDICAL OFFICER(S) (AMO(S)) ........................................................................................... 11 2.4 HUMAN RESOURCE OFFICER(S) .................................................................................................................................... 11 2.5 SAFETY OFFICER(S) .................................................................................................................................................... 12 2.6 HEALTH CARE PROVIDERS ........................................................................................................................................... 12 CHAPTER 3 - MEDICAL SERVICES PROVIDERS .............................................................................................................. 13 3.1 ACQUIRING OR ACCESSING SERVICES ............................................................................................................................. 13 3.2 EXAMINING HEALTH CARE PROVIDER QUALIFICATION STANDARDS/CREDENTIALS .................................................................. 13 CHAPTER 4 - MEDICAL RECORDS - EMPLOYEE MEDICAL FILE SYSTEM ......................................................................... 17 4.1 MANAGEMENT AND RECORDS MAINTENANCE ................................................................................................................ 17 4.2 CONFIDENTIALITY/RELEASE OF RECORDS ........................................................................................................................ 19 CHAPTER 5 - MEDICAL PROGRAM GUIDANCE ............................................................................................................. 22 5.1 ESTABLISHING AND PROVIDING SERVICES ....................................................................................................................... 22 5.2 UNION-MANDATED ................................................................................................................................................... 23 5.3 MEDICAL REVIEW PROGRAM ....................................................................................................................................... 23 5.4 BASIC REQUIREMENTS FOR EXAMINATION PROCEDURES ................................................................................................... 23 5.5 DISCRETIONARY SERVICES ........................................................................................................................................... 27 5.6 EMERGENCY MEDICAL CARE. ....................................................................................................................................... 30 5.7 HOW TO ESTABLISH OR CHANGE MEDICAL QUALIFICATION STANDARDS FOR HAZARDOUS AND/OR ARDUOUS POSITIONS ............. 31 5.8 PRE-PLACEMENT MEDICAL EVALUATIONS ...................................................................................................................... 34 5.9 MEDICAL SURVEILLANCE ............................................................................................................................................. 39 5.10 SPECIAL EMPHASIS TOPICS .......................................................................................................................................... 44 Drug and Alcohol Testing Employee Assistance Program Services Reasonable Accommodation Time and Attendance / Conduct / Performance Authority to require an examination Authority to offer an examination Medical Employability Determinations OWCP Recordable Injuries and Illnesses CHAPTER 6 – COMMON OCCUPATIONAL HEALTH TOPICS ........................................................................................... 51 6.1 RESPIRATORY PROTECTION/MEDICAL CLEARANCE. .......................................................................................................... 51 6.2 HEARING CONSERVATION ........................................................................................................................................... 56 6.3 OCCUPATIONAL HAZARDS ........................................................................................................................................... 57 A. Chemical Stressors ...................................................................................................................................................... 57 2 B. Physical Stressors ........................................................................................................................................................ 59 Exertion ...................................................................................................................................................................... 62 Heat Stress/Heat related illness ................................................................................................................................. 62 Cold Stress .................................................................................................................................................................. 62 C. Biological Stressors ...................................................................................................................................................... 70 Bloodborne Pathogens ............................................................................................................................................... 70 Vaccine-Preventable Diseases .................................................................................................................................... 71 Other biological stressors Tuberculosis ....................................................................................................................................................... 72 Rabies ................................................................................................................................................................ 73 Hantavirus ......................................................................................................................................................... 74 Mosquito Borne Diseases .................................................................................................................................. 75 Lyme Disease……………….………………………………………………………………………..………………………………………………….. 76 Poisonous Plants…………………………..……………………………………….…………..…………………………………………………………78 6.4 DRIVING FOR WORK PURPOSES .................................................................................................................................... 79 6.5 AUTOMATIC EXTERNAL DEFIBRILLATORS ........................................................................................................................ 81 6.6 FIRST AID KITS .......................................................................................................................................................... 83 CHAPTER 7 - MEDICAL STANDARDS ............................................................................................................................ 86 COMMISSIONED LAW ENFORCEMENT OFFICERS ........................................................................................................................ 87 WILDLAND FIREFIGHTERS ................................................................................................................................................... 106 DIVERS ..........................................................................................................................................................................